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Bone macromorphology at muscle attachment sites: its relationship with the microarchitecture of the underlying bone and possible implications for the reconstruction of habitual physical activities of past populations

Background: The term “enthesis” is usually used to mark the sites of muscle
attachments, as well as attachments of ligaments and joint capsules to bones. In the last
three decades, studies concerning entheses in human skeletal remains have attempted to
reconstruct the habitual physical activities of past populations. The evaluation of
entheseal morphological appearance was suggested for the identification of gross
workload patterns, which could be used in the interpretation of labour division on a
gender, age or social basis in ancient populations.
There have been four major research streams in literature with regard to entheses and
entheseal changes (EC). The first group of studies mainly focused on the analysis of the
histological structure of the attachment site. The second group of studies focused of
visual scoring methods based on the macromorphological features of the attachment
surface with the aim of evaluating the degree of muscle use. The third group included
studies dealing with

the relationship between EC and the biomechanical properties of
long bones, while a fourth group of studies was aimed at reconstructing the habitual
physical activities of past populations, using visual scoring methods.
Regardless of the fact that habitual physical activities or stress patterns of past
populations are frequently reconstructed based on EC, there is no direct experimental
evidence for the relationship between muscular activity and particular macroscopic
entheseal scores.
Although entheses were investigated from macroscopic, histological and biomechanical
aspects, it is surprising that microarchitectural studies of the underlying bone are still
lacking, despite the well-known potential of bone microarchitecture to reflect
mechanical loading. It is widely accepted that the bone adapts its structure to changes in
its mechanical environment, and a number of studies have reported the relationship
between bone microarchitecture and loading patterns in different skeletal sites.
However, despite numerous studies reporting that bone morphology is affected by
mechanical loads and that bone has a self-optimising capability, there is no
comprehensive study dealing with this issue in the region of the entheses...